“…32 The pharmacokinetic interactions between herbal therapies and drugs, including AEDs, have been inadequately studied. Available evidence suggests that St. John's wort, 33 garlic, echinacea (various Echinacea species), pine bark extract (Pinus pinaster; also known as pycnogel, Pygenol, or Pycnogenol), milk thistle (Silybum species), American hellebore (Veratrum viride), ginkgo, 10,11 mugwort (Artemisia species), and pipsissewa (Chimaphila umbellata) affect the cytochrome P450 system and could therefore potentially affect serum concentrations of hepatically metabolized AEDs, [21][22][23][24][25][26][27][28][29][30][31][32][33][34] perhaps with fatal consequences. 10 …”